Build and attempt quizzes

Question (AKT-style; select THREE)

Mrs Jones, a 61-year-old woman, presents with 6 months of gradually worsening shortness of breath on exertion. Over the past 4 weeks she has developed orthopnoea (now using 2 pillows) and occasional waking at night feeling breathless. She has a persistent dry cough but no fever or sputum. She denies pleuritic chest pain, haemoptysis and calf pain. She reports intermittent central chest tightness with heavy exertion that settles within 5 minutes of rest, but no current chest pain and no syncope.

Past history: hypercholesterolaemia and long-standing hypertension (poor adherence). Medications: atorvastatin; intermittently takes her antihypertensive (unsure of name). Social: ex-smoker (20 pack-years; quit 5 years ago). Family history: father had MI at 62.

Examination: afebrile, HR 82 bpm regular, BP 165/97 mmHg, RR 18, SpO2 96% room air. JVP not elevated. Chest clear with good air entry bilaterally, no wheeze. Heart sounds normal, no audible murmur. Mild bilateral ankle oedema. Weight has increased by 3 kg over 2 months.

You suspect possible early heart failure or ischaemic heart disease but respiratory causes remain in the differential. In Australian general practice, which THREE investigations are the most appropriate to order initially to help clarify the diagnosis and guide next steps?

Jamie is a 14-year-old Aboriginal boy who presents with his mother to your regional general practice. She is worried he has been sniffing petrol with other teenagers after school. She reports he has missed a lot of school this term and there has been increasing conflict at home, including shouting and occasional property damage when limits are set.

Jamie is quiet in the consult and says he has been “hanging out” with friends at night because he feels stressed and “doesn’t want to think”. He has no significant past medical history and is not taking regular medications. Mum asks why this might be happening and what puts young people at risk.

You acknowledge the importance of culturally safe care and offer an Aboriginal health worker involvement if the family would like. You also consider child safety and the need to assess for neglect, family violence, and other safeguarding concerns.

Which of the following are recognised risk factors for volatile substance use in adolescents? (Select 3.)

Stephanie Kyte, a 14-year-old on doxycycline for acne, presents with a new history of recurrent nosebleeds and bleeding from her gums. An urgent full blood count shows an isolated thrombocytopenia with a platelet count of 95 x10^9/L. You diagnose likely drug-induced thrombocytopenia.

In addition to ceasing the doxycycline, what is the single most important piece of safety-netting advice to provide to Stephanie and her family?

A 62-year-old man presents to your general practice for follow-up after seeing a cardiologist for exertional chest tightness. The cardiologist has diagnosed stable angina (coronary artery disease) and has advised ongoing management in primary care.

He has a history of hypertension and type 2 diabetes. He is an ex-smoker (30 pack-years) and is overweight. Current medicines are perindopril 5 mg daily and metformin 1 g twice daily. He has no history of gastrointestinal bleeding, no aspirin allergy, no asthma/COPD, and no bradycardia or heart block on his recent ECG.

He asks what the most important long-term management steps are to reduce symptoms and future cardiovascular events.

Task: Select the THREE most important long-term management actions.

A 45-year-old woman presents with 6 months of exertional right calf pain that occurs after walking about 150–200 metres and reliably settles within 2–3 minutes of rest. She has no rest pain, no night pain, no non-healing ulcers, no colour change, and no acute onset limb pain or numbness. She is systemically well and haemodynamically stable.

Risk factors include a 20 pack-year smoking history (currently smoking), dyslipidaemia, and type 2 diabetes (HbA1c 7.6%). She is taking metformin, atorvastatin and an ACE inhibitor. On examination her right dorsalis pedis pulse is reduced compared with the left, capillary refill is normal, and there are no signs of infection. An ankle–brachial pressure index (ABPI) is 0.72 on the right and 0.98 on the left, consistent with peripheral arterial disease (PAD) and intermittent claudication.

Select THREE non-pharmacological management actions you would recommend now in Australian general practice.

John, a 45-year-old childcare worker, presents with a 2-day history of painful mouth ulcers and a rash on his hands and feet. He reports a low-grade fever, malaise and reduced oral intake because swallowing is painful. Two children at his workplace were recently sent home with a viral rash illness.

On examination he is alert, afebrile in clinic, and appears mildly uncomfortable. Oral examination shows multiple shallow ulcers on the buccal mucosa and soft palate. There are small vesicles on the palms and soles. He is haemodynamically stable with no signs of meningism or respiratory distress and is able to sip water.

You diagnose hand, foot and mouth disease.

Which non-pharmacological advice is most appropriate to give today?

Select exactly 3 options.